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Claim by Michael WongTHE CITY OF DUB UE MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL ,of› To: Mayor Roy D. Buol and Members of the City Council DATE: August 18, 2010 RE: Claim Against the City of Dubuque by Michael Wong Claimant Date of Claim Date of Loss Nature of Claim Michael Wong 08/12/10 08/06/10 Vehicle Damage This is a claim in which claimant alleges that as he was driving onto Pennsylvania from JFK, he was rear -ended by a City of Dubuque minibus. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Barbara Morck, Transit Manager Michael Wong OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944 TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, Iowa. You should complete this form in full and attach any additional information that supports your claim. The claim must be filed with the City Clerk at City Hall, 50 West 13"' St., Dubuque, IA 52001. It will then be referred to the appropriate department for investigation and to the City Attomey's Office. Once that investigation is completed, a report and recommendation will be submitted to the City Council. You will be provided with a copy of that report and recommendation. The final decision on all claims is made by the City Council. No employee of the City of Dubuque has the authority to make any representation to you / as to whether your claim will or will not be paid. 1. Name of Claimant: 1C%A2 L 1 , LZCl 2. Address: �d � /.�r� � i'Lf Cry' GCS Z 3. Telephone Number. _5 _3 4. Date of Incident // 5. Time of Incident: /.; 6. Location of Incident (Be specific): 7. Describe the accident or occurrence that caused injury or damage. (Give full details upon which you base your claim. If a ity employee s involved, give the employee's mployee's name.) 44 /its' vNR��n L44/its' (sr- a rr, IA/ --zrleth C1IV to /29 7 4 44 4r 5- 7 F hddr - � 4/5e e�'ki L � �f /'N ✓'d`(i ; N A17 ts" 8. What were weather conditions like? ('/-P4 r 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) y� - tJ��511�i Ter / r 04, - 11. Was anyone in'u ? (If so, give names, addresses, and extent of injuries.) 12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.) , - �.PA. .^) 217 kyr 5 . 11 -P aA. d ra r ,r "Hp -Pr- 13. What other damages do you claim, if any? /1i i A ./-2.— 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.) Li 15. What amount do you claim from the City of Dubuque? S he 7///22 16. Why do you claim the City of Dubuque is responsible? L 711,A P f1.; 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated this // day of /7/ L (Print Name) 1 2/s7 ,20 /v. C.11 CD tD 08/10/2010 at 03:07 PM Job Number: 94524 Insured: MIKE WONG Owner: MIKE WONG Address: 2189 ST. JOHN DR. DUBUQUE, IA 52002 Other: (563)556 -2159 Inspect Location: Insurance Company: 2006 DODG DAKOTA 4X4 QUAD CAB SLT 6- 3.7L -FI 4D P/U Int: VIN: 1D7HW48K86S699119 Lic: Prod Date: Odometer: Tilt Wheel Cruise Control Air Conditioning Intermittent Wipers Dual Mirrors Clear Coat Paint Power Windows AM Radio Search /Seek Driver Air Bag Bucket Seats 4 Wheel Drive Keyless Entry Console /Storage Power Steering Power Locks FM Radio CD Player Passenger Air Bag Rear Step Bumper Overdrive NO. OP. DESCRIPTION 1 REAR BUMPER 2 Repl Bumper assy chrome 3 PICK UP BOX 4* Rpr LT Side panel quad cab 5 Add for Clear Coat 6 Repl Nameplate "4x4" black 7# HAZARDOUS WASTE 8# CAR COVER 9# STRIPES TURPIN DODGE OF DUBUQUE, LLC 90 KENNEDY RD DUBUQUE, IA 52001 (563)583 -5781 Fax: (563)556 -6928 PRELIMINARY ESTIMATE Written By: TERRY FORTMANN Adjuster: Subtotals = => 1 Claim # Policy # Deductible: Date of Loss: Type of Loss: Point of Impact: Days to Repair Tinted Glass Fog Lamps Power Brakes Power Mirrors Stereo Anti -Lock Brakes (2) Cloth Seats 6 Speed Transmission Aluminum /Alloy Wheels QTY EXT. PRICE LABOR PAINT 1 547.00 1.1 1 29.70 0.2 1 5.00 T 1 5.00 T 1 20.00 0.2 606.70 2.5 3.1 1.2 4.0 4.3 08/10/2010 at 03:07 PM Job Number: 94524 PRELIMINARY ESTIMATE 2006 DODG DAKOTA 4X4 QUAD CAB SLT 6- 3.7L -FI 4D P/U Int: Parts Body Labor Paint Labor Paint Supplies Sublet /Misc. SUBTOTAL Sales Tax GRAND TOTAL $ 1298.66 ADJUSTMENTS: Deductible CUSTOMER PAY INSURANCE PAY Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR3TF05, CCC Data Date 07/01/2010, and the parts selected are OEM -parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE /Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk ( *) or Double Asterisk ( * *) indicates that the parts and /or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign ( -) items indicate MOTOR Not - Included Labor operations. Non - Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign ( #) items indicate manual entries. Some 2010 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 2 596.70 4.0 hrs @ $ 55.00 /hr 220.00 4.3 hrs @ $ 55.00 /hr 236.50 4.3 hrs @ $ 35.00 /hr 150.50 10.00 $ 1213.70 $ 1213.70 @ 7.0000% 84.96 0.00 $ 0.00 $ 1298.66 Damage Assessed By: john klotz Deductible: Claim Number: Insured: Address: Telephone: Description: Body Style: VIN: OEM /ALT: Options: 0.00 8737 MIKE WONG 2189 ST JOHN DR, DUBUQUE, IA 52002 Home Phone: (563) 556-2159 Line Entry Labor Item Number Type Operation 1 001433 BDY REPAIR 2 AUTO REF REFINISH 3 001452 BDY REMOVE/REPLACE 4 900500 BDY* REMOVE/INSTALL 5 001663 BDY REMOVE/INSTALL 6 AUTO BDY OVERHAUL 7 002418 BDY REMOVE/REPLACE 8 AUTO REF ADD'L OPR 9 933005 BDY ADD'L OPR 10 933018 REF ADD'L OPR 11 AUTO ADD'L COST 12 AUTO ADD'L COST BIRD CHEVROLET 3255 UNIVERSITY AVE, DUBUQUE, IA 52001 (563) 583-9121 Fax: (563) 690-1423 Email johnklotz @birdchevrolet.com Tax ID: 42.0400210 Mitchell Service: 910339 2006 Dodge Dakota SLT 4D PkupCrw 5' Bed 131" WB Drive Train: 3.7L Inj 6 Cyl 4WD 1D7HW48K86S699119 0 Search Code: None PASSENGER AIRBAG, DRIVER SIDE AIRBAG, POWER LOCK, POWER WINDOW, POWER STEERING MANUAL AIR CONDITION, CRUISE CONTROL, TILT STEERING COLUMN, ANTI-LOCK BRAKE SYS. FOG LIGHTS, ALUM /ALLOY WHEELS, CD PLAYER, POWER ADJUSTABLE EXTERIOR MIRROR PRIVACY GLASS, KEYLESS ENTRY, CLOTH SEAT, TACHOMETER PASSENGER AIRBAG CUTOFF SWITCH/SENSOR Line Item Description L Pickup Bed Side Panel Assy L Bed Side Panel Outside L Pickup Bed Decal MUD GUARD L Rear Combination Lamp Rear Bumper Assy Rear Bumper Cover Assy Clear Coat Restore Corrosion Protection Mask For Overspray Paint/Materials Hazardous Waste Disposal * - Judgment Item # - Labor Note Applies C - Included in Clear Coat Calc r - CEG R &R Time Used For This Labor Operation ESTIMATE RECALL NUMBER: 08/10/2010 15:41:26 8737 Mitchell Data Version: OEM: JUL_10_V UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2010 Mitchell International UltraMate Version: 7.0.022 All Rights Reserved Date: 8/10/2010 03:41 PM Estimate ID: 8737 Estimate Version: 0 Preliminary Profile ID: Mitchell Part Type/ Part Number Existing 5JN44CA1AB Existing 55077653AE Dollar Labor Amount Units 2.0 *# C 2.5 33.20 0.2 0.2* r 0.2 0.8 547.00 INC 1.0 3.00 * 0.2* 5.00 * 122.50 * 3.50 * Page 1 of 2 III. Additional Costs Estimate Totals Add'l Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 3.6 57.00 3.00 0.00 208.20 T Taxable Parts 580.20 Refinish 3.5 57.00 5.00 0.00 204.50 T Sales Tax @ 7.000% 40.61 Taxable Labor 412.70 Total Replacement Parts Amount 620.81 Labor Tax @ 7.000 % 28.89 Labor Summary 7.1 441.59 Non-Taxable Costs 126.00 Insurance Deductible 0.00 Total Additional Costs 126.00 Customer Responsibility 0.00 Paint Material Method: Rates Init Rate = 35.00 , Init Max Hours = 99.9, Addl Rate = 0.00 ESTIMATE RECALL NUMBER: 08/10/2010 15 :41:26 8737 Mitchell Data Version: OEM: JUL_10_V UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2010 Mitchell International UltraMate Version: 7.0.022 All Rights Reserved Date: 8/10/2010 03:41 PM Estimate ID: 8737 Estimate Version: 0 Preliminary Profile ID: Mitchell Amount IV. Adjustments Amount I. Total Labor: 441.59 II. Total Replacement Parts: 620.81 III. Total Additional Costs: 126.00 Gross Total: 1,188.40 IV. Total Adjustments: 0.00 Net Total: 1,188.40 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. Page 2 of 2 Deductible: 0.00 Claim Number: 9386 Insured: Address: Telephone: Description: Body Style: VIN: OEM /ALT: Color: Options: Line Entry Labor Item Number Type 1 001439 BDY 2 AUTO REF 3 001450 BDY 4 AUTO BDY 5 002418 BDY 6 AUTO REF 7 933005 BDY 8 933018 REF 9 933019 BDY 10 AUTO 11 AUTO Mike Finnin Ford Damage Assessed By: Rick Stumpf MIKE WONG 2189 ST JOHN DR., DUBUQUE, IA 52002 Home Phone: (563) 556 -2159 2006 Dodge Dakota SLT 4D PkupCrw 5' Bed 131" WB Drive Train: 3.7L In) 6 CyI 4WD 1D7HW48K86S699119 0 Search Code: None TAN PASSENGER AIRBAG, DRIVER SIDE AIRBAG, POWER LOCK, POWER WINDOW, POWER STEERING MANUAL AIR CONDITION, CRUISE CONTROL, TILT STEERING COLUMN, ANTI -LOCK BRAKE SYS. FOG LIGHTS, ALUM /ALLOY WHEELS, CD PLAYER, POWER ADJUSTABLE EXTERIOR MIRROR PRIVACY GLASS, KEYLESS ENTRY, CLOTH SEAT, TACHOMETER PASSENGER AIRBAG CUTOFF SWITCH /SENSOR Operation REPAIR REFINISH REMOVE /REPLACE OVERHAUL REMOVE /REPLACE ADD'L OPR ADD'L OPR ADD'L OPR ADD'L OPR ADD'L COST ADD'L COST * - Judgment Item # - Labor Note Applies C - Included in Clear Coat Calc 3600 Dodge Street, Dubuque, IA 52003 (563) 556-1010 Fax: (563) 690 -1086 Email: bodyshop@finninautos.com Tax ID: 14- 1862673 Mitchell Service: 910339 Line Item Description L Pickup Bed Side Panel L Bed Side Panel Outside L Pickup Bed Decal Rear Bumper Assy Rear Bumper Cover Assy Clear Coat Restore Corrosion Protection Mask For Overspray Taped Stripe Paint/Materials Hazardous Waste Disposal ESTIMATE RECALL NUMBER: 08/10/2010 15:27:32 9386 Mitchell Data Version: OEM: JUL_10_V UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2010 Mitchell International UltraMate Version: 7.0.022 All Rights Reserved Date: 8/10/2010 03:27 PM Estimate ID: 9386 Estimate Version: 0 Preliminary Profile ID: Mitchell Part Type/ Part Number Existing 5JN44GX9AB 55077653AE Dollar Labor Amount Units 2.0*# C 2.3 29.70 0.2 0.8 547.00 INC 0.9* 4.00 * 0.1* 10.00 * 34.00 * 0.2* 115.20 * 5.00 * Page 1 of 2